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Low-Risk Prostate Cancer Patients with No Record of Treatment

Key findings

Approximately 81% of men with low-risk prostate cancer (ages 35 and older) had no record of treatment, suggesting these patients were likely on active surveillance or watchful waiting.

Why is this important to Ontarians?

Many prostate cancer cases are slow-growing, and therefore will not cause harm if left untreated. To mitigate the risks associated with over-treatment, active surveillance (monitoring the patient closely and providing treatment only if the disease progresses) is recommended for many men with low-risk prostate cancer.[1]

See Low-Risk Prostate Cancer Patients with No Record of Treatment Methodology for technical information.

Report date: April 2019
Data sources: Ontario Cancer Registry (OCR), Cancer Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Prepared by: Analytics and Informatics, Cancer Care Ontario
Note: High volumes of unknown or invalid codes exist for prostate-specific antigen (PSA) value, Biopsy Gleason Score, and Clinical T stage. As a result, the number of low risk prostate cancer cases (ages 35 and older) diagnosed from 2012 to 2016 might be under-estimated.

Data Table 1. Percentage of men with low-risk prostate cancer (ages 35 and older) with no record of treatment (i.e., active surveillance, watchful waiting), diagnosed from 2012 to 2016
Year of diagnosis Percentage (%)
2012 60.1
2013 66.5
2014 71.2
2015 78.3
2016 81.1

Report date: April 2019
Data sources: Ontario Cancer Registry (OCR), Cancer Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Prepared by: Analytics and Informatics, Cancer Care Ontario
Note: High volumes of unknown or invalid codes exist for prostate-specific antigen (PSA) value, Biopsy Gleason Score, and Clinical T stage. As a result, the number of low risk prostate cancer cases (ages 35 and older) diagnosed from 2012 to 2016 might be under-estimated.

Results

  • In 2016, 81% of men with low-risk prostate cancer (age 35 and older) had no record of treatment, and these rates have steadily increased from 60% in 2012. This indicates that Ontario is performing well in regard to the rising rate of “expectant management” of prostate cancer. Expectant management is defined as avoiding problems that may be caused by treatments such as radiation or surgery.
  • These cases cannot all be considered as active surveillance or watchful waiting because some patients could have refused treatments.

Comparisons

Getting comparable data and measures from multiple jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside of Ontario. Jurisdictional comparison is still useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

  • Ontario is performing well among other provinces in Canada, as most low-risk prostate cancer patients did not receive treatment.
  • Among participating provinces, the percentage of low-risk prostate cancer patients who did not receive treatment ranged from 42% to 77%. Specifically, the rates by province: British Columbia – 47%, Alberta – 42%, Saskatchewan – 49%, Manitoba – 74%, Nova Scotia – 43%, Prince Edward Island – 76%.[2] However, data from the other provinces are from the 2010 diagnosis year.

Opportunities

  • In Ontario, active surveillance (or watchful waiting, where appropriate) is the preferred management option for men with low-grade prostate cancer. For information on the role of active surveillance as a management strategy, see Cancer Care Ontario’s guideline, Active Surveillance for the Management of Localized Prostate Cancer.
  • Cancer Care Ontario will continue to develop quality measures to accurately measure the number of low-risk prostate cancer patients on active surveillance.

References

  1. Choosing wisely in cancer control across Canada - a set of baseline indicators. Current Oncology [Internet]. 2017 June [cited 2019, April 09]; 24(3): 201-206. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486386/pdf/conc-24-201.pdf
  2. Canadian Partnership Against Cancer. 2018 Cancer System Performance Report [Internet]. (2018) [cited 2019, April 09]. Available from https://www.systemperformance.ca/disease-sites/prostate/treatment/prostate-patterns-of-care-radiation-and-surgical-treatment/#!figures